Spleen Biopsy in Pediatric Medicine
Splenic biopsy is a specialized diagnostic procedure used to evaluate various splenic pathologies in pediatric patients. It requires careful consideration due to the organ's vascularity and potential complications.
Key Points:
- High-risk procedure requiring expert handling
- Usually performed under image guidance
- Essential for diagnosis of specific splenic conditions
- Requires careful patient selection and preparation
- Alternative diagnostic methods should be considered first
Primary Clinical Indications
- Unexplained splenomegaly
- Suspected splenic malignancies:
- Primary lymphoma
- Metastatic disease
- Histiocytic disorders
- Unexplained focal splenic lesions
- Systemic diseases with splenic involvement:
- Storage diseases
- Hemophagocytic lymphohistiocytosis (HLH)
- Sarcoidosis
- Fever of unknown origin with splenic involvement
Contraindications
- Absolute:
- Severe coagulopathy
- Severe thrombocytopenia (<50,000/μL)
- Hemodynamic instability
- Relative:
- Moderate thrombocytopenia (50,000-100,000/μL)
- Abnormal coagulation parameters
- Active infection in the region
Procedure Techniques
Pre-procedure Requirements
- Laboratory Studies:
- Complete blood count
- Coagulation profile (PT, PTT, INR)
- Type and cross-match
- Imaging:
- Recent CT or MRI
- Ultrasound mapping
- Fasting Requirements:
- 6 hours for solids
- 4 hours for clear liquids
Biopsy Methods
- Fine Needle Aspiration (FNA):
- 22-25 gauge needle
- Less invasive
- Limited sample yield
- Core Needle Biopsy:
- 18-20 gauge needle
- Better tissue architecture preservation
- Higher diagnostic yield
Imaging Guidance Techniques
Ultrasound Guidance
- Most commonly used method
- Real-time visualization
- Advantages:
- No radiation exposure
- Real-time needle tracking
- Visualization of vascular structures
CT Guidance
- Used for:
- Deep lesions
- Poor ultrasound windows
- Complex anatomical approaches
- Considerations:
- Radiation exposure
- Need for contrast in some cases
- Better 3D anatomical orientation
Complications and Management
Major Complications
- Hemorrhage:
- Immediate recognition essential
- May require transfusion
- Potential need for surgical intervention
- Adjacent Organ Injury:
- Stomach
- Left kidney
- Left lung base
Post-procedure Care
- Monitoring Requirements:
- Vital signs every 15 minutes for 2 hours
- Hemoglobin check at 4-6 hours
- Observation for minimum 6 hours
- Pain Management Protocol
- Activity Restrictions:
- Bed rest for 4-6 hours
- No strenuous activity for 1 week
Follow-up Care
- 24-hour follow-up call
- Clinical review in 1 week
- Result discussion appointment
